Effect of Consumption of Cape Gooseberries on Blood Glucose Control Among Patients with Type 2 Diabetes Mellitus in Kampala, Uganda: A Protocol for a Randomized Controlled Trial

Aggressive Control of Intraoperative Blood Glucose Concentration

Objective To explore the effect of different blood glucose monitoring frequency on blood glucose fluctuation and control in type 2 diabetes mellitus patients with intensive insulin therapy. Methods One hundred and twenty type 2 diabetes mellitus patients With intensive insulin therapy were chosen and randomly divided into three groups. The three times group received 3 times monitoring including fasting, after breakfast and bedtime, and the five times group received 5 times monitoring including fasting, after breakfast, before supper, bedtime and before dawn, and the eight times group received the 8 times monitoring including before and after every meal, bedtime and before dawn, and the changes of the hemoglobin Alc （I-IbAlc） were observed for 4 weeks before and after the treatment. Results The average levels of HbA1 c in the three groups were decreased 4 weeks after treatment in the three groups, and the difference was not statistically significant （ F = 0. 301, P 〉0.05 ）. No difference was found in the fasting blood glucose and blood glucose before supper in the three groups （ F = 1. 450, t = 1. 760 ; P 〉 0.05 ）. The levels of blood glucose after breakfast were respectively （ 8.78 ± 0.90）, （9.08 ± 0.63 ）, （7.49 ± 1.01 ） mmol/L in the three groups, and the level of blood glucose in the eight times group was better than those of the three and five times groups, and the difference was statistically significant （F = 23. 340, P 〈 0.05 ）. The levels of bedtime blood glucose were respectively （ 8.07 ± 0.59 ）, （8.32 ± 0.75）, （7.28 ± 0.54） mmol/L in the three groups, and the blood glucose fluctuatian range in the eight times group was lowest, and the difference was statistically significant （F = 32.880, P 〈 0.0.5）. The levelof blood glucose before dawn in the eight times group was （6. 68 ± 0.59 ） mmol/L, and was better than （7.75 ±0.77） mmol/L in the five times group, and the difference was statistically significant （t =4. 170, P 〈 0.01 ）. The average levels of 24 h blood glucose in the three groups were respectively （8.33 ± 1.20）, （8.26 ± 0.97）, （7.84 ± 1.15 ） mmol/L, and the blood glucose control in the eight times group was best, and the difference was statistically significant （ F = 22.36, P 〈 0.05 ）, and the detection rate of hypoglycemia was 33.3% in the small hours. Conclusions The blood glucose fluctuation range in the eight times group is minimum. The many times blood glucose monitoring in type 2 diabetic patients with intensive insulin therapy, at least 3 times daily, can reduce and prevent the incidence of hypoglycemia. Key words: Diabetes mellitus, type 2 ; Blood glucose self monitoring; Frequency ; Intensiveinsulin therapy; Blood glucose control

Blood glucose and pressure controls in diabetic kidney disease: Narrative review of adherence, barriers and evidence of achievement

Diabetes is associated with HCC; however, the impact of longitudinal blood glucose (BG) control on HCC risk in cirrhosis is not well known. We investigated this knowledge gap in a cohort of United States Veterans with cirrhosis from 2015 to 2021. We used repeated hemoglobin A1c measurements to categorize follow-up time according to BG control (defined as hemoglobin A1c < 7%) state over time: uncontrolled, nonsustained control (≤2 y), or sustained control (>2 y). We performed a sensitivity analysis using hemoglobin A1c < 8% to define BG control. We used Fine and Gray Cox proportional hazards regression with death and transplant as competing events to compare rates of incident HCC. Our study included 81,907 individuals, 56.2% of whom had diabetes at baseline. There were 8,002 incident HCCs. The rate of HCC was 18% higher in diabetes (95% CI: 13% - 24%), and the relative increase in the rate of HCC varied by etiology of cirrhosis from nonsignificant (HCV) to an increase of 120% (HBV). Uncontrolled and nonsustained BG control was associated with 1.80 (95% CI: 1.70-1.91) and 2.34 (95% CI: 2.21-2.48) times the rate of HCC compared to sustained BG control, respectively. Using Hgb A1c < 8% to define BG control, HCC rates in uncontrolled and nonsustained BG control were 2.43 (2.28-2.58) and 2.23 (2.11-2.36) times that observed in sustained BG control. Associations between diabetes and HCC in cirrhosis vary according to the longitudinal BG control state. Inadequate BG control is consistently associated with a higher risk of HCC, and long-term BG control should be considered in comprehensive cirrhosis care.

Derangement of glucose metabolism after surgery is not specific to patients with diabetes mellitus. We investigated the effect of different degrees of blood glucose control (BGC) on clinical outcomes after cardiac surgery. We analyzed 8727 adults operated on between April 1996 and March 2004. The highest blood glucose level recorded over the first 60 hours postoperatively was used to classify patients as having good (<200 mg/dL), moderate (200 to 250 mg/dL), or poor (>250 mg/dL) BGC; 7547 patients (85%) had good, 905 (10%) had moderate, and 365 (4%) had poor BGC. Patients with inadequate BGC were more likely to present with advanced New York Heart Association class, congestive heart failure, hypertension, renal dysfunction, and ejection fraction <50% (P0<or=.001). We found that 52% of patients with poor, 31% with moderate, and 8% with good BGC had diabetes mellitus. Inadequate BGC, but not diabetes mellitus (P=0.79), was associated with in-hospital mortality (good, 1.8%; moderate, 4.2%; poor, 9.6%; adjusted odds ratio: poor versus good BGC, 3.90 [95% confidence interval, 2.47 to 6.15]; moderate versus good BGC, 1.68 [95% confidence interval, 1.25 to 2.25]). Inadequate BGC also was associated with postoperative myocardial infarction (eg, odds ratio, poor versus good BGC: 2.73 [95% confidence interval, 1.74 to 4.26]) and with pulmonary and renal complications in patients without known diabetes mellitus (eg, odds ratio, poor versus good BGC: 2.27 [95% confidence interval, 1.65 to 3.12] and 2.82 [95% confidence interval, 1.54 to 5.14] respectively). More than 50% of patients with moderate to poor BGC after cardiac surgery were not previously identified as diabetic. Inadequate postoperative BGC is a predictor of in-hospital mortality and morbidity.

The effects of blood glucose control upon fracture healing in the BB Wistar rat with diabetes mellitus

Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson's chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1-46.8%) had controlled BP, 57.1% (95% CI: 51.7-62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7-26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.

Hypertension and diabetes are major risk factors for cardiovascular diseases and optimal control of blood pressure (BP) and blood glucose are associated with reduced cardiovascular disease events. This study, therefore, sought to estimate the prevalence and associated factors of controlled BP and blood glucose levels among patients diagnosed with both hypertension and Type 2- diabetes mellitus (T2DM). A quantitative cross-sectional study was conducted in a primary health setting in Ghana among patients 18 years and older diagnosed with both hypertension and T2DM. Pearson’s chi-square was used to assess the association between BP and blood glucose levels and the independent variables. The multivariable binary logistic regression model was used to assess the adjusted odds of controlled BP and blood glucose levels. Among the 329 participants diagnosed with both hypertension and T2DM, 41.3% (95% CI: 36.1–46.8%) had controlled BP, 57.1% (95% CI: 51.7–62.4%) had controlled blood glucose whilst 21.8% (95% CI: 17.7–26.7%) had both controlled BP and blood glucose levels. Increased age, non-formal education, non-married, employed, single-dose anti-hypertensives or anti-diabetic medications, and hyperlipidaemia or stroke co-morbidities were positively associated with controlled BP levels. Being female, married, taking 2 or more anti-hypertensive medications, and moderate to high medication-related burden were positively associated with controlled blood glucose levels. In terms of both controlled BP and blood glucose levels, being employed, reduced income level, being registered with national health insurance, single anti-diabetes or anti-hypertensive medications, hyperlipidaemia or stroke co-morbidities, and moderate to high medication-related burden were positively associated with having both controlled BP and blood glucose levels. One in five patients with hypertension and T2DM had both BP and blood glucose levels under control. The benefits and risks of blood pressure and blood glucose targets should thus be factored into the management of patients with hypertension and T2DM.

The Interactions Between Physicians and Dentists in Managing the Care of Patients With Diabetes Mellitus

The goal of this study was to assess patient perspectives and satisfaction with the MiniMed 670G insulin pump. Those participants who used the pump as part of a hybrid closed loop were also asked to provide their views on the automatic feature (auto mode). Adults with type 1 diabetes mellitus using the Medtronic™ 670G pump were asked about their experience with the device using a semi-structured survey developed by the research team. Responses were quantified to identify emergent themes. Seventeen participants used the pump as part of a hybrid closed loop system, while four participants used the pump in combination with a nonintegrated continuous glucose monitoring system. Overall, participants indicated a high level of satisfaction with the pump (14/21) mostly because of improvements in blood glucose (BG) control (15/21). Least liked features were physical design and structure (6/21), frequency of user input (5/21), alert frequency (4/21), and difficulty of use (3/21). Those using the hybrid closed loop were satisfied with the auto mode feature (11/17), mostly because of improvements in BG control (9/17). The least liked features of the auto mode technology were that blood glucose levels remained elevated (5/17) and the frequency of alerts (4/17). Participants indicated a high level of satisfaction with the pump and its auto mode featured mostly because of improvements in BG control. They also pointed out some key aspects of the device that are of potential clinical or commercial relevance. Additional research is needed to further evaluate users' perspectives on this new device.

<b>Abstract ID 17705</b> <b>Poster Board 505</b> Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder caused by the autoimmune destruction of insulin-producing beta-cells of the pancreas. Insulin, the mainstay of treatment for T1DM, is often inadequate for optimal blood glucose (BG) control with dangerous side effects such as hypoglycemia. Adjunct therapies have been proposed to provide better BG control and reduce hypoglycemic episodes. Dapagliflozin, a potent sodium-glucose co-transporter 2 (SGLT2) inhibitor, is a new class of hypoglycemic agents for type 2 diabetes, and its potential as an adjunct therapy to insulin in T1DM has been confirmed in clinical studies. However, the increased risk of diabetic ketoacidosis associated with dapagliflozin is a major concern preventing its clinical usage as an adjunct therapy for T1DM. To this end, the efficacy and safety of dapagliflozin in streptozotocin (60 mg/kg)-induced diabetic rats were evaluated using in&nbsp;vivo (3 weeks of baseline after diabetes induction and 8 weeks of treatment) and ex vivo studies. Male Sprague Dawley rats (300-400 g) were divided into 5 groups (n=4-6): healthy, diabetic control, diabetic treated with insulin, diabetic treated with insulin+dapagliflozin (1 mg/kg PO daily), and diabetic treated with dapagliflozin alone. Treatment with insulin or insulin+dapagliflozin caused diabetic rats to maintain body weight with reduced urination and water intake compared to diabetic control. Insulin+dapagliflozin provided better BG control with reduced total insulin injection as compared to insulin alone. Dapagliflozin, as expected, increased urine output and water intake. Lipid panel including total cholesterol, TAG, and HDL was not significantly different in rats treated with insulin+dapagliflozin vs insulin alone. Ex vivo studies indicated a trend of higher kidney weight/body weight and increased sizes of glomeruli in rats treated with insulin+dapagliflozin as compared to diabetic control or healthy rats. Moreover, a significant increase in beta-cell regeneration was observed in the rats treated with insulin alone or insulin+dapagliflozin as compared to diabetic control rats. The plasma concentration of ketones under various experimental conditions will be determined using a beta-hydroxybutyrate assay kit to assess diabetic ketoacidosis. The significance of this study is investigating the effects of dapagliflozin in a type 1 diabetic animal model, which allows ex vivo studies to assess its effects on multiple individual organs and tissues. <b>Support/Funding Information:</b> Southern Illinois University Edwardsville internal research grant Southern Illinois University Edwardsville research grants for graduate students

Strict blood glucose (BG) control is proved to improve the outcome in patients with glucose intolerance both in acute and chronic phases, irrespective of whether the patient has diabetes mellitus. However, strict BG control by conventional methods is so complicated that it cannot be performed easily in normal clinical situations. Furthermore, it is sometimes inadequate. Therefore, a clinically applicable, reliable artificial pancreas (AP) has long been sought after for more than 40 years. Considering the present important situations concerning AP, a survey of recent progress in AP is highly desirable. In this review, recent progress in mechanical AP (MAP) and in MAP-related items is presented. MAP is composed of three major components: a BG control algorithm, a drug administration system, and a glucose sensor. Recent progress in development of these components is presented, followed by descriptions of representative MAPs. Although significant progress in the development of MAP has been made, its use in clinical situations is limited or for research purposes at present. The main limiting factor is the slow progress in the development of glucose sensors. However, more widespread clinical application of the MAP will occur in the near future, considering the number of reliable long-life intravenous glucose sensors under development. Another factor is the worldwide recognition of the importance of BG control in acutely ill patients, in whom the period of strict BG control is usually for several days to a few weeks.

Reinforcement learning application in diabetes blood glucose control: A systematic review.

Objective To explore the blood glucose control status, influencing factors, and self-management level of patients before participating in diabetes self-management groups in the Nanjing community, and to provide baseline data and the scientific basis for the community to promote self-management activities for diabetic patients. Methods From April to June 2017, patients in diabetes self-management groups were recruited through the use of multi-stage cluster random sampling. Prior to the self-management group activities, patients were surveyed for general conditions, physical examinations and blood glucose and blood lipid tests were conducted, and the Chronic Disease Self-Management Research Measurement Form was used to investigate the patient's self-management level face to face. Results A total of 345 diabetic patients were included, and 342 effective scales were returned with an effective rate of 99.1%. The age of the 342 patients with diabetes was (63.8±8.7) years, 129 (37.7%) were male and 213 (62.3%) were female. The average levels of FPG and HbA1c were (7.61±2.23) mmol / L and (7.15±1.57) %, respectively. The FPG and HbA1c control compliance rates were 44.7% (153 cases) and 52.3% (179 cases), respectively. The level of FPG [(7.85±2.32) mmol/L compared with (7.29±2.07) mmol/L] and HbA1c[(7.31±1.78) mmol/L compared with (6.93±1.23) mmol/L] was higher in patients with a diabetes course ≥5 years than that of patients with diabetes course <5 years, and the level of HbA1c [(7.30±1.64) mmol/L compared with (6.92±1.44) mmol/L] was higher in patients with primary school education and below than that in junior high school and above. Compared with the non-control group, the proportion of married patients (42.9%, 132 cases) in the FPG control group was lower, with lower levels of BMI [(23.38±3.27) kg/m2vs. (26.27±3.40) kg/m2], waist circumference [(84.47±10.97) cm vs. (88.74±10.48) cm], and hip circumference [(94.46±8.68) cm vs. (97.40±9.92) cm]. In the HbA1c control group, the proportion of males (44.2%, 57 cases), those with primary school education or below (47.3%, 97 cases), and those with a diabetes course ≥5 years (44.1%, 86 cases) were lower. BMI [(25.52±3.50) kg/m2vs. (26.26±3.19) kg/m2], waist circumference [(85.34±11.63) cm vs. (88.47±9.80) cm], systolic blood pressure [(132.65±14.73) mmHg vs. (136.15±15.14) mmHg], total cholesterol [(4.41±1.08) mmol/L vs. (4.76±1.11) mmol/L], and triacylglycerol [(1.67±0.72) mmol/L vs. (1.92±1.12) mmol/L] were all lower, and the levels of HDL [(2.73±0.97) mmol/L was higher than that of (2.48±1.02) mmol/L], with statistically significant differences (all P <0.05). In terms of the level of self-management, compared with the non-control group, the weekly stretching and/or strength training time of the FPG control group was (26.27±41.27) min higher than (17.06±33.46) min, and the difference was statistically significant (P<0.05); HbA1c control group weekly stretch and/or strength exercise time (7.32±20.82) min vs. (16.47±14.33) min, weekly endurance exercise time (105.67±50.75) min vs. (91.66±51.07) min, symptom management self-efficacy (6.87±1.62) points (6.36±1.93) points were higher, fatigue (2.52±2.23) points(3.07±2.54) points, dyspnea (0.27±0.82) points (0.67±1.46) points, social. Both the activity and/or role restriction scores (0.58±0.64) and (0.74±0.79) scores were lower, and the differences were statistically significant (all P<0.05). Conclusions Patients with diabetes in communities in Nanjing have better blood glucose control and higher levels of self-management. Patients with good control of BMI, blood pressure and blood lipids have higher blood glucose compliance rates. Communities with conditions can gradually promote self-management group activities to further control patients' blood glucose levels and reduce the incidence of complications. Key words: Diabetes; Blood glucose control; Influencing factors; Self-management

On the basis of strong research evidence and consensus, type 1 diabetes mellitus (DM) remains the most common form of DM in children and adolescents. The incidence of type 2 DM in the pediatric population is rapidly increasing because of the obesity epidemic, and minority groups are disproportionately affected. (2) (10) (19) On the basis of some research evidence and consensus, it can be challenging to initially differentiate between type 2 DM and type 1 DM clinically because of the increased prevalence of obesity, the complex interplay of autoimmunity and obesity, and common symptoms at presentation. (1) (10) (19) Significant evidence and consensus support a genetic basis for the development of type 2 DM in children. Physicians should routinely screen at risk children older than age 10 years for DM. Screening criteria include obesity, a family history of type 2 DM, a minority racial or ethnic background, acanthosis nigricans, or other diseases associated with insulin resistance, including polycystic ovary syndrome, hypertension, or dyslipidemia. (1) (10) (18) (19) On the basis of consensus, diagnosis of type 2 DM can be confirmed by an elevated fasting blood glucose level greater than 126 mg/dl (7.0 mmol/L), an elevated 2-hour plasma glucose greater than 200 mg/dL (11.1 mmol/L) on an oral glucose tolerance test, an elevated random blood glucose greater than 200 mg/dL (11.1 mmol/L), or a hemoglobin A1c level greater than 6.5% with suggestive symptoms. (10) According to strong research evidence and consensus, once the diagnosis has been made, treatment should be based on the acuity of presentation and should focus on lifestyle modification and on normalizing hyperglycemia to minimize complications. Metformin is currently first-line treatment for type 2 DM in children and adolescents older than age 10 years who present nonacutely. (18) (19) Strong research evidence and consensus demonstrate that because type 2 DM has an insidious onset, microvascular and macrovascular complications can be present at the time of diagnosis. Patients should be screened for the presence of complications when the diagnosis of type 2 DM is made and in follow-up. (6) (10).